BREAKING NEWS: 2014 CPT Coding Changes

The CPT coding changes for 2014 have just been released. Understanding the new codes is crucial to obtaining the proper reimbursement for your services and ADVOCATE has analyzed the changes and provided the highlights below.

The changes in reimbursement that will result from these CPT coding changes is not known yet because the 2014 Medicare fee schedule is not yet released.  However, it’s a safe bet that the net result will be a decrease in reimbursement, the real unknown is how much of a decrease. 

One new possible opportunity for increased reimbursement is the addition of Inter-professional telephone/Internet assessment and management codes.  Again, at this point the reimbursement for these codes is unknown.  We will provide more information on the actual service level and documentation requirements for these codes as it established.

CPT 2014 will once again see significant changes in vascular and non-vascular interventional radiology. More minor changes will occur in diagnostic x-ray, radiation therapy, and E&M services. All of the CPT changes are effective January 1, 2014. Below are highlights of the changes that will most commonly affect radiology practices.  For a complete list of 2014 Additions, Deletions and Revisions, click here.

Break Away from the Static

DIAGNOSTIC RADIOLOGY

One code for cervical spine x-rays has again been revised this year, further clarifying CPT code assignment based on the number of views only.

72040 Radiologic examination, spine, cervical; 2 or 3 views

RADIATION THERAPY

The existing code for 3D radiation therapy simulation has been revised to include the dosimetry.

77295  3-dimensional radiotherapy plan, including dose-volume histograms    

VASCULAR INTERVENTIONAL RADIOLOGY

CPT 2014 is following the ongoing trend in interventional radiology with the creation of comprehensive codes that include all radiologic supervision & interpretation.

TRANSCATHETER STENT PLACEMENT

The existing stent placement codes 37205-37208 and 75960 have been replaced by 4 new codes.   These comprehensive codes include all radiologic supervision and interpretation, any associated angioplasty, and no longer have a designation based on open or percutaneous approach.  These codes are not to be used in areas of the body where other more specific codes currently exist (lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary).

37236  Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery    

37237  Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure)    

37238  Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein   

37239  Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure) 

TRANSCATHETER EMBOLIZATION

Embolization codes have undergone significant changes in 2014.  Four new codes replace existing embolization codes of 37210 (uterine fibroid embolization) and the non-CNS, non-head embolization code, 37204.  It is important to note that the existing embolization codes for CNS (61624) and intracranial (61626) embolization are still active. Because the new codes do not make a distinction based on CNS or intracranial, this may lead to some confusion in the proper code selection.  Advocate will be at the forefront of these discussions.

The major distinction in the new codes is the reason for embolization (e.g.,  AVMs, varices, hemorrhage, tumor, ischemia, infarct, etc.).  These codes also are defined by arterial or venous and once again include all radiological supervision and interpretation required to perform the procedure.

37241  Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)

37242  Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas,    aneurysms, pseudoaneurysms)                                   

37243  Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction                                       

37244  Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation  

NON-VASCULAR INTERVENTIONAL RADIOLOGY

BREAST PROCEDURES

Percutaneous breast procedures will see many changes in 2014.  Nine new comprehensive codes have replaced the existing biopsy (19102/19103), clip (19295), and localization (19290/19291) procedure codes.  Procedure codes will now include any procedures commonly performed at the time of biopsy (clip placement, specimen radiograph, etc.) Codes are based on the type of radiologic guidance, which is now included in the code, and also based on the number of lesions treated. Other percutaneous breast procedures such as preoperative needle/wire localization, clip placement, and radiotherapy can be coded when done as a stand-alone procedure and not in conjunction with a biopsy.

19081  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance                                           

19082  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)                                    

19083  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance                                                 

19084  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to codefor primary procedure)                                              

19085  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance                                          

19086  Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) 

19281  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance                          

19282  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)                           

19283  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance                                      

19284  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)                          

19285  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance                                        

19286  Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)                            

19287  Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance        

19288  Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) 

ABSCESS DRAINAGE

Four new abscess drainage codes have been created in CPT 2014 which replace all existing site specific abscess drainage codes.  The new codes include radiologic guidance.  Three codes are percutaneous and are based on body site-soft tissue, visceral, and peritoneal/retroperitoneal; the other code is for peritoneal/retroperitoneal abscess drainage via a transvaginal or transrectal approach.

10030  Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, soft tissue (eg, extremity, abdominal wall, neck), percutaneous

49405  Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous                     

49406  Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous                                                       

49407  Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal  

VASCULAR SURGERY

Eight new codes were granted for endovascular repair of visceral abdominal aorta.  These procedures were previously assigned Category III* codes 0078T-0081T. 

34841  Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)           

34842  Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])                                              

34843  Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])                                                     

34844  Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including four or  more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])                                

34845  Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)                     

34846  Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])               

34847  Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])                

34848  Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])   

*Category III codes are temporary codes created for emerging technology, services, and procedures.  Use of these Category III codes allows data collection for these services and procedures.

EVALUATION & MANAGEMENT

A new category of E&M services has been introduced in CPT 2014 for interprofessional telephone/internet assessment and management services. 

99446  Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

99447  Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review

99448  Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review

99449  Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review      

Best regards,
Jennifer Bash, RHIA, CPC, CIRCC, RCC
Coding Documentation & Education Manager